Surgery in acute leukemia: a review of 167 operations in thrombocytopenic patients.

Of 435 consecutive patients with acute leukemia, 95 patients had 167 operations with a platelet count of less than 100 X 10(9)/L and 130 operations with platelet counts of less than 50 X 10(9)/L. Only 7% of operations had intraoperative blood loss of greater than 500 ml, and 7% required greater than 4 units of red cells transfused in the perioperative period. No patient died of bleeding attributable to surgery within 1 month of the operation. Granulocyte count was less than 0.5 X 10(9)/L in 66% of operations with 57% febrile preoperatively. However, no patient developed infection within the surgical field in the postoperative month. Logistic regression analyses were used to assess preoperative factors, which identified those operations at risk for excessive bleeding or postoperative surgical complications. Major (group 1) operations, preoperative fever, and preoperative coagulation abnormalities were associated with operations with an intraoperative blood loss greater than 500 ml and/or perioperative red blood cell RBC transfusions greater than 4 units (P less than .001). Surgery in cytopenic patients with acute leukemia is safe provided optimal supportive care is available.